Translational gastroenterology and hepatology最新文献

{"title":"Co-existing regeneration mechanisms in severe alcohol-related steatohepatitis.","authors":"Adrienne Lejeune, Peter Stärkel, Alexandre Louvet, Axel Hittelet, Céline Bazille, Boris Bastens, Hans Orlent, Luc Lasser, Xavier Dekoninck, Sergio Negrin Dastis, Jean Delwaide, Anja Geerts, Christophe Moreno, Chantal de Galocsy, Virginie Putzeys, Phillippe Langlet, Hendrik Reynaert, Sven Francque, Mina Komuta, Nicolas Lanthier","doi":"10.21037/tgh-24-92","DOIUrl":"10.21037/tgh-24-92","url":null,"abstract":"<p><strong>Background: </strong>Keratin 7 positive (K7⁺) cells are considered to be activated in case of impaired hepatocyte replication. Their exact role and their interaction with hepatocytes and macrophages also implicated in liver regeneration remain poorly characterized in humans. The aim of this study is to evaluate hepatocyte, K7⁺ cells and macrophage populations in severe alcohol-related steatohepatitis (sASH) and to link them with liver injury and patients' outcomes.</p><p><strong>Methods: </strong>Immunohistochemical and morphometric studies for total K7⁺ cells, macrophages (CD68⁺ cells), proliferative hepatocytes (Ki67⁺ hepatocytes) and proliferative K7⁺ cells (double K7⁺ and Ki67⁺) were performed on liver biopsies of patients with sASH recruited prospectively in 16 different centres. Patients were divided into improvers or non-improvers, according to mortality and model for end-stage liver disease (MELD) score change at 3 months.</p><p><strong>Results: </strong>Fifty-seven cases were included for histological and morphometrical assessment. Liver total K7⁺ cell expansion was positively correlated to the severity of the disease evaluated by the MELD score. A proportion of these K7⁺ cells were proliferating. The number of proliferating K7⁺ cells was less than the number of proliferating hepatocytes. Increased hepatocyte replication was correlated to a higher proliferative K7⁺ cell count. A higher number of macrophages was associated with a higher proliferation of both hepatocytes and K7⁺ cells. No difference of total K7⁺ cells, proliferative K7⁺ cells, proliferative hepatocytes or macrophages was observed between improvers and non-improvers.</p><p><strong>Conclusions: </strong>In biopsy-proven cases of sASH, proliferation of hepatocytes and K7⁺ cells occurs in parallel. This could suggest that liver progenitor cells begin to replicate even in the absence of massive hepatocyte senescence in humans, or that proliferating progenitor cells are capable of giving rise to hepatocytes with replicative skills. This is associated with macrophagic expansion, which is therefore considered beneficial. However, in this severe, life-threatening disease, these mechanisms remain insufficient to improve patient prognosis.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"3"},"PeriodicalIF":3.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged preoperative evaluation of potential living donors for liver transplantation.","authors":"Camila Sotomayor, Daniel García, Patricia Rebolledo, Maria Pilar Dominguez, Antonia Pastoré, Pablo Achurra, Eduardo Viñuela, Juan Pablo Arab, Carlos Benitez, Alvaro Huete, Eduardo Briceño, Jorge Martinez, Nicolas Jarufe, Martin J Dib","doi":"10.21037/tgh-24-65","DOIUrl":"10.21037/tgh-24-65","url":null,"abstract":"<p><strong>Background: </strong>Living donor selection is crucial to minimize postoperative donor complications and to improve recipient outcomes. This study describes the selection process and evaluates the reasons for discarding potential donors in our living donor liver transplantation (LDLT) program.</p><p><strong>Methods: </strong>Retrospective descriptive analysis from all potential donors evaluated in our LDLT program between April 2018 and July 2021. Selection criteria included age 18-60 years old, no significant medical or mental comorbidities, ABO and anatomical suitability.</p><p><strong>Results: </strong>A total of 231 potential donors were evaluated. Mean age was 37.2±11.1 years and male gender in 51.9%. One hundred and one potential donors (43.7%) did not complete the evaluation, mainly because of availability of a deceased donor during the process (n=32; 13.9%), ABO incompatibility (n=14; 6.1%), progression or death of the recipient (n=20; 8.7%). Of the 130 who completed their radiological evaluation, 55 (42.3%) were anatomically unsuitable, mainly due to small liver remnant size (n=25/130; 19.2%) and steatosis (n=17/130; 13.1%). Out of the 231 potential donors, 75 were accepted as adequate donors (32.5%) and 36 candidates underwent liver donation (15.6%).</p><p><strong>Conclusions: </strong>Only one-third of all potential donors are suitable for donation and half of them will undergo surgery. Given that in our setting computed tomography (CT) has a lower cost than magnetic resonance imaging (MRI), starting with a CT scan decreases the high cost of further workup of donors that are not anatomically suitable for living liver donation.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"2"},"PeriodicalIF":3.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymph node metastases status in esophageal squamous cell carcinoma following neoadjuvant chemoradiotherapy: a single-center cross-sectional study.","authors":"Anh Tuan Nguyen, Van Hiep Pham, Manh Thang Tran, Pham Nghia Do Nguyen","doi":"10.21037/tgh-24-76","DOIUrl":"10.21037/tgh-24-76","url":null,"abstract":"<p><strong>Background: </strong>The status of lymph node (LN) metastases in esophageal squamous cell carcinoma (ESCC) following neoadjuvant chemoradiation (NCRT) is not well understood but significantly affects patient prognosis and treatment options. We conducted this study to evaluate the distribution of LN metastases in patients with ESCC who received NCRT combined minimally invasive esophagectomy (MIE).</p><p><strong>Methods: </strong>From March 2019 to September 2023, patients with middle- and lower-third ESCC received NCRT, followed by MIE with two-field lymphadenectomy, were included in this study. The primary outcome was to examine the distribution of LN metastases and their correlation with the radiation fields. Secondary outcomes included identifying risk factors for LN metastases and their impact on long-term survival.</p><p><strong>Results: </strong>One hundred consecutive patients were included, and 4.11% had LN metastases. The median number of positive LN and the rate of LN metastases in the thoracic LN stations was lower than that of the abdominal region (1.5 and 2.84% <i>vs.</i> 2 and 5.94%, respectively). Over half of the patients had LN metastases within the radiation field. The multivariate analysis found that the LN metastases were associated with the ycN-stage [hazard ratio (HR) =2.03, 95% confidence interval (CI): 1.02-4.04, P=0.04]. Although the LN metastases were not significantly associated with either overall survival (OS) or disease-free survival (DFS) (P=0.89 and P=0.65, respectively), the number of LN removal ≥15 LN removals was significantly improved both OS and DFS (P=0.040 and P=0.049, respectively).</p><p><strong>Conclusions: </strong>In patients with middle- and lower-third ESCC who underwent NCRT followed by MIE, the rate of LN metastases in the abdominal region is higher than in the thoracic region. The majority of patients had LN metastases within the radiation field. Therefore, NCRT does not justify minimizing lymphadenectomy in ESCC; furthermore, a higher ycN-stage correlated with a higher incidence of LN metastases; higher ycN-stage correlates with higher LN metastases.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"8"},"PeriodicalIF":3.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pan-gastrointestinal adenocarcinoma analysis uncovers the prognostic and immune correlates of ferroptosis-related genes.","authors":"Xiaochuan Dong, Yanyan Xie, Wenxi Chen, Mengjiang He, Hua Liu, Bin Wang, Yu Xu, Qiaoxia Zhou, Tengfei Zhu, Guoqiang Wang, Chunwei Xu, Wenxian Wang, Shangli Cai, Meili Xu, Jingjing Wang","doi":"10.21037/tgh-24-15","DOIUrl":"10.21037/tgh-24-15","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal adenocarcinomas (GIACs) are common malignant tumors with poor prognosis in the world. Ferroptosis, characterized by the accumulation of intracellular iron and lipid reactive oxygen species, emerges as a pivotal process in tumorigenesis and cancer advancement. However, the implications of ferroptosis-related genes in GIAC remain to be elucidated. This study aimed at exploring the potential role of ferroptosis-related genes on the prognosis and treatment of GIAC.</p><p><strong>Methods: </strong>In our study, comprehensive clinical, transcriptomic, and/or genomic data were acquired from The Cancer Genome Atlas (TCGA), Cancer Cell Line Encyclopedia (CCLE), Genomics of Drug Sensitivity in Cancer (GDSC), and Gene Expression Omnibus (GEO). We formulated a ferroptosis-score within the TCGA cohort through gene set variation analysis (GSVA) and subsequently validated in 4 GEO datasets (GSE84437, GSE17536, GSE103479, and GSE19417). Drug sensitivity and immunotherapy efficacy were analyzed in the GDSC dataset and the PRJEB25780 cohort, respectively.</p><p><strong>Results: </strong>The ferroptosis-score was significantly associated with favorable overall survival both in the training cohort [TCGA: P=0.003; hazard ratio (HR), 0.67, 95% confidence interval (95% CI): 0.52-0.87] and across the four validation cohorts (GSE17536: P=0.03; HR, 0.57, 95% CI: 0.34-0.96; GSE19417: P=0.047; HR, 0.53, 95% CI: 0.28-1.01; GSE84437: P=0.004; HR, 0.68, 95% CI: 0.51-0.90; GSE103479: P=0.03; HR, 0.55, 95% CI: 0.32-0.96). Furthermore, the ferroptosis-score was correlated with activation of the DNA damage repair pathway and resistance to cisplatin. Notably, GIACs with low ferroptosis-scores exhibited heightened expression of immune checkpoint molecules such as programmed death-(ligand) 1 and cytotoxic T lymphocyte antigen-4, elevated densities of tumor-infiltrating CD8+ T cells, and a favorable response to pembrolizumab monotherapy.</p><p><strong>Conclusions: </strong>Our findings delineated the clinical relevance of ferroptosis-related genes in GIACs and demonstrated the potential utility of the ferroptosis-score in predicting prognosis and immunotherapy effectiveness.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"7"},"PeriodicalIF":3.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal combination regimen for a patient with advanced huge hepatocellular carcinoma: a case report.","authors":"Shan Li, Zhen-Feng Zhou, Hao-Jian Long, Jia-Xin Yin, Hui-Zhong Wang, Jian-Fu Zhao","doi":"10.21037/tgh-24-91","DOIUrl":"10.21037/tgh-24-91","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is a highly malignant tumor of the digestive system with a poor prognosis. Huge HCC, a subtype characterized by tumors measuring at least 10 cm in diameter, often presents with macrovascular invasion, satellite nodules, metastases, and other aggressive characteristics, posing significant challenges for treatment. The era of combined targeted therapy and immunotherapy has brought new hope to patients with advanced HCC. The development of innovative combination medication regimens for HCC is a current area of intense clinical research interest. We are trying to explore new combination therapies based on target-immunity combination therapy in the hope of better-benefiting patients with advanced huge HCC.</p><p><strong>Case description: </strong>We present a patient with Barcelona Clinical Liver Cancer Stage C huge HCC who was treated with combined targeted therapy and immunotherapy as the primary therapeutic regimen, supplemented with tegafur long-term metronomic chemotherapy, as well as specialized adjuvant therapy such as thymosin, bisphosphonates, antiviral medication, and vitamin C supplementation. The tumor size was significantly reduced and microwave ablation was performed, after which, the patient was kept on the combination regimen, resulting in a partial response (PR), and maintaining PR without disease progression for 32 months.</p><p><strong>Conclusions: </strong>The combination regimen may enhance advanced huge HCC treatment and provide a new multimodal drug strategy for HCC.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"17"},"PeriodicalIF":3.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound-guided gastroenterostomy: a review.","authors":"Edwin Golikov, Jessica Widmer","doi":"10.21037/tgh-23-51","DOIUrl":"10.21037/tgh-23-51","url":null,"abstract":"<p><p>Gastric outlet obstruction (GOO) occurs due to anatomic blockage of the stomach or duodenum. GOO typically manifests with symptoms such as early satiety, nausea, vomiting, and weight loss, due to either underlying benign or malignant causes. Historically, the gold standard for managing GOO has been surgical gastrojejunostomy. However, this approach comes with considerable drawbacks including prolonged recovery times and the necessity for suitable surgical candidates. Endoscopically placed self-expanding metal stents emerged as a notable advancement in palliating symptoms associated with GOO. However, their long-term efficacy is hindered by the frequent occurrence of stent occlusion, necessitating the need for further intervention. Most recently, endoscopic ultrasound guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents has been described with promising technical and clinical success rates. The advent of EUS-GE heralds a significant stride forward in the management of GOO, offering a less invasive yet effective alternative to conventional surgical approaches. EUS-GE has been associated with lower adverse events as compared with surgical gastrojejunostomy and lower recurrence and reintervention rates compared with enteral stenting. The advent of EUS-GE heralds a significant stride forward in the management of GOO, offering a less invasive yet effective alternative to conventional surgical approaches. EUS-GE is a promising evolving technique for treating GOO, and ongoing studies are necessary to validate its use in both benign and malignant GOO.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"13"},"PeriodicalIF":3.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling risk factors for delayed bleeding following ultrasonography-guided liver biopsy: a retrospective analysis.","authors":"Tao Jiang, Qunying Li, Ju Li, Tianan Jiang","doi":"10.21037/tgh-24-79","DOIUrl":"10.21037/tgh-24-79","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous liver puncture remains the gold standard for diagnosis of liver lesions, though image-guided techniques reduce the incidence of complications, there remains a risk of severe delayed bleeding. This study aimed to analyze the risk factors associated with delayed bleeding complications after ultrasonography-guided liver biopsy.</p><p><strong>Methods: </strong>In this retrospective study, we enrolled a total of 642 patients who underwent ultrasonography-guided percutaneous liver biopsy at our institution between January 2022 and December 2023. Data on patient characteristics, laboratory results, radiographic findings, bleeding complications, and treatments were extracted from the electronic medical records (EMR) system of the hospital. This study aimed to identify the differences in clinical characteristics between post-biopsy bleeding and non-bleeding groups as well as between early and delayed post-biopsy bleeding groups. Propensity score matching (PSM) algorithms were employed to mitigate the impact of sample size on the results.</p><p><strong>Results: </strong>After exclusion screening, a total of 627 patients were included in this study. Of these, 233 (37.16%) were men and 394 (62.84%) were women. The primary reason for liver puncture was liver transplantation (45.29%). Eleven cases of post-biopsy bleeding were observed, where eight were mild (72.73% of total cases exhibiting bleeding and 1.27% of total punctures) and three were serious (27.27% of total cases displaying bleeding and 0.48% of total punctures). Serious bleeding was delayed in all patients exhibiting bleeding. No bleeding-related risk factors were identified in either the overall cohort or the PSM cohort. Nevertheless, our findings indicate that patients with delayed bleeding exhibited lower platelet counts and were more likely to present with hydrothorax or ascites.</p><p><strong>Conclusions: </strong>There were no statistically significant differences in any of the baseline characteristics between patients with and without post-biopsy bleeding. However, when patients presented with platelets below the normal range in conjunction with hydrothorax or ascites, there was an increased risk of delayed bleeding.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"4"},"PeriodicalIF":3.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of hepatitis B virus reactivation prevention measures in immunosuppressed patients: current status and effectiveness.","authors":"Toru Ishikawa, Mitsuyuki Suzuki, Terasu Honma, Toshiaki Yoshida","doi":"10.21037/tgh-24-103","DOIUrl":"10.21037/tgh-24-103","url":null,"abstract":"<p><strong>Background: </strong>Prevention of hepatitis B virus (HBV) reactivation is a very important issue, but there is still no clear strategy. This study aimd to develop and evaluate an in-hospital collaboration flow to prevent HBV reactivation, guided by the Japanese Society of Hepatology (JSH) guidelines.</p><p><strong>Methods: </strong>We have strengthened and implemented a screening system and for HBV reactivation from February 2022 to January 2023. We assessed the administration of nucleic acid analogs (NAs) in hepatitis B surface antigen (HBsAg) or HBV DNA-positive cases, the detection rate of HBs or hepatitis B core (HBc) antibodies in HBsAg or HBV DNA-negative cases, and the follow-up status of HBV DNA testing. A total of 1,195 patients were included, with exclusions based on the judgement of no need for testing by the attending physician.</p><p><strong>Results: </strong>Among 1,172 tested patients, 1.88% (n=22) were HBsAg or HBV DNA-positive, all of whom received NA therapy. Among 1,150 HBsAg or HBV DNA-negative cases, 9.91% (n=114) were HBs or HBc antibody-positive, with 82.5% (n=94) undergoing HBV DNA testing. Over the years, the HBV DNA measurement rates increased significantly to 82.5% in 2022.</p><p><strong>Conclusions: </strong>The implemented screening regimen resulted in high and improving testing rates over time. Most HBsAg or HBV DNA-positive cases were treated with tenofovir alafenamide (TAF), highlighting its potential benefits in terms of safety and adherence. Continued validation and adaptation of the screening system are necessary to further prevent HBV reactivation.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"5"},"PeriodicalIF":3.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elimination of hepatitis C in the Middle East: a narrative review of the efficacy of direct-acting antiviral therapies.","authors":"Catherine Coxeter-Smith, Ria B Gaglani, Robert D Ingram, Oliver T Kidd, Anjana S Kumar, Amin Alhadad, Laith Alrubaiy","doi":"10.21037/tgh-24-87","DOIUrl":"10.21037/tgh-24-87","url":null,"abstract":"<p><strong>Background and objective: </strong>Hepatitis C virus (HCV), is a major health concern in the Middle East. Recent advances in direct-acting antivirals (DAAs) have transformed the treatment of HCV. The DAA chosen depends on the HCV genotype (GT) responsible for the infection, presence of cirrhosis, and prior treatment attempts. In addition, factors such as human immunodeficiency virus (HIV) co-infection and renal impairment can influence treatment. This literature review aims to discuss and appraise evidence on the efficacy and safety of the DAAs currently licensed for hepatitis C treatment in the Middle East.</p><p><strong>Methods: </strong>Supporting publications from the National Institute for Health and Care Excellence (NICE) and European Association for the Study of the Liver guidelines were searched manually. A literature search of PubMed, MEDLINE, Cochrane Library, and EMBASE databases was performed with search terms including 'HCV', 'clinical trial', and the seven combinations of DAA combinations recommended by NICE. Papers from January 2016 to January 2021 were considered, along with seminal papers outside this range.</p><p><strong>Key content and findings: </strong>Of 390 publications found, 62 were included. In most studies, DAAs showed high efficacy in the recommended GTs, cirrhosis states, and prior HCV treatments. DAAs were found to be generally safe and well-tolerated: the most common side effects throughout were headache and nausea. Serious adverse events (SAEs) were seen when ribavirin and peginterferon alfa were taken in combination with the DAA.</p><p><strong>Conclusions: </strong>This review demonstrates the strong evidence for the efficacy and safety of DAAs. The focus of HCV research should shift from efficacy of treatment to investigating accessible screening and diagnostics in order to achieve the World Health Organisation's (WHO's) goal of eradicating HCV by 2030.</p>","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"10"},"PeriodicalIF":3.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 13-year nationwide analysis of outcomes of non-variceal upper gastrointestinal bleeding in post-bariatric surgery patients.","authors":"James R Pellegrini, Andrej M Sodoma, Samuel Greenberg, Sonika Rathi, Nicholas Knott, Richard Pellegrini, Jaspreet Singh","doi":"10.21037/tgh-24-100","DOIUrl":"10.21037/tgh-24-100","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization and associated morbidity and mortality. Bariatric surgery is a widely performed category of gastrointestinal (GI) surgery that attempts to induce weight loss by reconstructing the upper GI tract. Bleeding is a common complication of bariatric surgery; however, limited research exists on outcomes for these patients when admitted for NVUGIB compared to those without a history of bariatric surgery. Our study aims to evaluate the outcomes of post-bariatric surgery patients (PBSPs) admitted with NVUGIB over a 13-year span.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The National Inpatient Sample (NIS) from 2008 to 2020 was used to identify patients over 18 years old admitted for NVUGIB using the International Classification of Disease (ICD), 9&lt;sup&gt;th&lt;/sup&gt; revision (ICD-9) and 10&lt;sup&gt;th&lt;/sup&gt; revision (ICD-10) codes. Records were weighted using the algorithms provided by the NIS. Primary outcomes of interest were all-cause hospital mortality, shock, acute myocardial infarction (AMI), acute kidney injury (AKI), and a composite of these. Groups were defined based on the history of bariatric surgery, and demographics and incidence of comorbidities were compared. Outcomes were compared between the two groups, and odds ratios (ORs) were calculated using two-stage weighted logistic regression. ORs were adjusted for common co-founders such as age, gender, race, Charlson comorbidity index (CCI), region, hospital size, hospital teaching status, elective &lt;i&gt;vs.&lt;/i&gt; emergency admission, and income quartile.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 2,231,826 patients admitted for NVUGIB were included in this study. Of these, 28,167 had a history of bariatric surgery. Overall, bariatric surgery patients were younger, less complicated (CCI: 2.71 &lt;i&gt;vs.&lt;/i&gt; 4.76), had a shorter length of stay (LOS), and were less likely to be on Medicare/Medicaid than those without a history of bariatric surgery (P&lt;0.05). Several comorbidities were more common in patients without a history of bariatric surgery, including coronary artery disease, hyperlipidemia (HLD), congestive heart failure (CHF), type 2 diabetes mellitus (T2DM), end-stage renal disease (ESRD), and liver cirrhosis (P&lt;0.05). Other comorbidities were more common in the post-bariatric surgery group, including gastroesophageal reflux disease and anemia (P&lt;0.05). We found that patients admitted for NVUGIB with a history of bariatric surgery had significantly lower odds of all outcomes, including all-cause mortality (OR =0.48; P&lt;0.001), AKI (OR =0.71; P&lt;0.001), AMI (OR =0.62; P&lt;0.05), shock (OR =0.88; P&lt;0.05), and a composite of these four (OR =0.77; P&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study found that patients with NVUGIB and a history of bariatric surgery had substantially decreased odds of mortality, AMI, shock, and AKI compared to patients without a history of bariatric surgery. This suggests","PeriodicalId":94362,"journal":{"name":"Translational gastroenterology and hepatology","volume":"10 ","pages":"6"},"PeriodicalIF":3.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}